Provider Demographics
NPI:1699284901
Name:WILLIAM BEE RIRIE HOSPITAL
Entity type:Organization
Organization Name:WILLIAM BEE RIRIE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-289-3001
Mailing Address - Street 1:1500 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301
Mailing Address - Country:US
Mailing Address - Phone:775-289-3001
Mailing Address - Fax:775-289-6423
Practice Address - Street 1:5043 TENABO AVENUE
Practice Address - Street 2:WILLIAM BEE RIRIE HOSPITAL CRESCENT VALLEY CLINIC
Practice Address - City:CRESCENT VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89821
Practice Address - Country:US
Practice Address - Phone:775-468-0250
Practice Address - Fax:775-468-0255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM BEE RIRIE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8857207Q00000X, 363AM0700X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty